title: Identification of performance indicators for emergency centres in South Africa: results of a Delphi study.
abstract: BACKGROUND
  Emergency medicine is a rapidly developing field in South Africa (SA) and other developing nations. There is a need to develop performance indicators that are relevant and easy to measure. This will allow identification of areas for improvement, create standards of care and allow inter-institutional comparisons to be made. There is evidence from the international literature that performance measures do lead to performance improvements.
  
  
  OBJECTIVE
  To develop a broad-based consensus document detailing quality measures for use in SA Emergency Centres (ECs).
  
  
  METHODS
  A three-round modified Delphi study was conducted over e-mail. A panel of experts representing the emergency medicine field in SA was formed. Participants were asked to provide potential performance indicators for use in SA, under subheaders of the various disciplines that are seen in emergency patients. These statements were collated and sent out to the panel for scoring on a 9-point Lickert scale. Statements that did not reach a predefined consensus were sent back to the panellist for reconsideration.
  
  
  RESULTS
  Consensus was reached on 99 out of 153 (65%) of the performance indicators proposed. These were further refined, and a synopsis of the statements is presented, classified as to whether the statements were thought to be feasible or not in the current circumstances.
  
  
  CONCLUSIONS
  A synopsis of the useful and feasible performance indicators is presented. The majority are structural and performance-based indicators appropriate to the development of the field in SA. Further refinement and research is needed to implement these indicators.
  
  
  BACKGROUND
  The online version of this article (doi:10.1007/s12245-010-0240-6) contains supplementary material, which is available to authorized users.
authors.affiliation: Division of Emergency Medicine, University of Cape Town and Stellenbosch University, Private Bag X24, Bellville, 7535 South Africa.
authors.forename: David
authors.initials: D
authors.lastname: Maritz
authors.forename: Peter
authors.initials: P
authors.lastname: Hodkinson
authors.forename: Lee
authors.initials: L
authors.lastname: Wallis